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Circumcision significantly reduces HIV/AIDS risk

A pair of studies carried out in Kenya and Uganda have shown that men who are …

While the news warns people about the pending bird flu or possible Ebola epidemic, the world is currently in the midst of a true pandemic. Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) currently affects more than 38 million people worldwide, has killed an estimated 25 million others, and doesn't show any real signs of stopping. A new set of clinical trials have revealed something previously believed, but never proved: circumcised men contract HIV through heterosexual intercourse at a rate that is nearly half that of their uncircumcised counterparts. The clinical trials were carried out in Kenya and Uganda, with the results being announced last week by the National Institutes of Health (NIH), which also said that it was stopping the trials because it was unethical to subject the uncircumcised men to the additional risk.

This finding confirms an earlier hypothesis built around the fact that HIV spreads more slowly in areas of Africa where circumcision is a more common practice. AIDS/HIV experts around the world hailed the finding, as it adds another weapon in the global fight against HIV/AIDS. The American Academy of Pediatrics stated in 1999 and reaffirmed in 2005 that the present data (at the time of publication, e.g., 1999 and 2005) was not sufficient to recommend routine neonatal circumcision. Clearly they did not have this new data, so the question remains: what makes circumcision an effective matter of slowing the spread of HIV/AIDS? The researchers offered up two possibilities. First, the underside of the foreskin has a heavy concentration of Langerhan cells—one of the first lines of defense of the immune system—which will readily attach to the HIV virus. Second, the foreskin isn't a strong piece of tissue and can often suffer from small tears during intercourse which can allow a direct pathway into the blood stream for the virus to enter.

This study was carried out with two separate groups of men: almost 3,000 in Kenya and nearly 5,000 in Uganda. The men were initially not infected with HIV, were given safe sex instructions, and then were regularly checked for infection. Among those in the study, the circumcised Kenyan men were found to have a reduction of 53 percent in contracting new cases of HIV, and the Ugandan men showed a similar result with a reduction of 48 percent. These numbers are in line with a South African trial carried out last year that reported a nearly 60 percent reduction in new HIV infections among men who were circumcised.

It is also clearly stated in the report and subsequent discussions that while circumcision can provide a reduction in risk, it is by no means a panacea or HIV/AIDS magic bullet. Circumcision brings its own risks, especially when done in remote villages that do not have access to sterile equipment—here the risk of infection is very real. Circumcision also only lowers the risk during heterosexual intercourse, not intravenous drug use or anal sex, which are two common infection vectors in the United States. This study brings with it the attention of two of the largest HIV/AIDS relief groups; both the Global Fund to Fight AIDS, Tuberculosis and Malaria and President Bush's Emergency Plan for AIDS Relief will donate significant amounts of money to countries who request help to ensure safe, sterile circumcisions for those who would want them. However, Dr. Mark Dybul, executive director of Emergency Plan for AIDS Relief, has said that this is only one step in fighting HIV/AIDS. According to him (and common sense) "Prevention efforts must reinforce the A.B.C. approach — abstain, be faithful, and correct and consistent use of condoms."

While this is good news both for the global community at large and men in particular, it also contains good news for women as well. A similar study showed carried out in Uganda showed that women had a 30 percent reduced rate of contracting HIV from a circumcised partner, which while not the 50 percent reduction benefit that men get, is still significant. A separate circumcision study published in the New England Journal of Medicine found that uncircumcised men were almost three times as likely to carry the human papillomavirus as were circumcised men who had a similar sexual history, a similar transmission mechanism is thought to be responsible.

Though this will not stop the raging pandemic that we all face today, it does add another layer of security; another step one can take to help slow this deadly disease. Hopefully as drug researchers continue to develop new stop gaps, such as reverse transcriptase inhibitors, novel retrovirial medications, and along with safe sex practices—now including circumcision—are heeded by more and more people around the world this scourge on humanity can see its final days.

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Matt Ford
Matt is a contributing writer at Ars Technica, focusing on physics, astronomy, chemistry, mathematics, and engineering. When he's not writing, he works on realtime models of large-scale engineering systems. Emailzeotherm@gmail.com//Twitter@zeotherm